Bulletin of Semashko National Research Institute of Public Health

Timely, systematic, affordable drug provision is aimed at compensating for chronic non-infectious and infectious diseases in patients, incl. preferential category of citizens who often have comorbid pathologies. Purpose of the study: Assessing the effectiveness of organizing an office for dispensing preferential medications (LLO office) for the timely provision of privileged categories of citizens, improving the quality and accessibility of medical care in medical organizations providing primary health care. Materials and methods: Data from BI reports of the unified medical information and analytical system of the Moscow region (EMIAS MO) on the number of prescriptions written for preferential drug coverage, of which in the medical dispensary office, of which with the use of telemedicine consultations in 13 outpatient departments of the state budgetary institution of the Moscow region «Lyubertsy Regional Hospital «(Lyuberetskaya OB). Methods: statistical, analytical, observation, timing, mapping, SWOT analysis. Results: The organization of the MLO office made it possible to solve a number of tasks: reducing the time for receiving prescriptions for MLO, increasing the coverage of medical examinations and follow-up of patients receiving MLO, referring patients for vaccination, increasing accessibility to specialized doctors and general practitioners. Conclusion: Centralization of the process of issuing prescriptions for medical prescriptions using digital technologies (telemedicine consultations, electronic prescriptions, reports on a personalized application for medications and the patient receiving them at the pharmacy) allows you to effectively organize the provision of medications to patients, as well as carry out preventive measures and timely correction of therapy.

The aim of the study was to identify the prevalence of postnatal depression (PND) symptoms, awareness of PND and assess the acceptability of PND screening among women in the first year after childbirth.
Materials and methods. An online survey of 360 women over the age of 18 living in Russia with at least one child under 1 year was conducted. The questionnaire included questions about attitudes toward mental and physical symptoms that women with small children may experience, awareness of PND and attitudes toward screening for it, as well as 13 questions from the Edinburgh Postnatal Depression Scale (EPDS) and 2 questions from the Patient Health Questionnaire (PHQ-2) used for screening Results. Awareness of PND is low: experiencing various symptoms indicating the presence of PND is considered normal by 7% of respondents (it is normal to think that the family would be better off without it) to 72% (it is normal to feel tired all the time). 89% of women (320 people) were not diagnosed with PND either during pregnancy or after childbirth. Despite the fact that 88% (317 people) of respondents believe that seeking help for PND is useful, only 18% (65 people) sought advice. The majority of respondents (281 people, 78%) are ready to undergo screening for PND. 45±5.2% of women scored 12 or more points on the ESPD, which presumably indicates PRD, 13±4.4% scored from 7 to 11 points (pre-threshold state or early stage of development of PRD symptoms). According to the OZP questionnaire, PRD or the pre-threshold stage can be suspected in 73±8.2% of women. A statistically significant connection was found between the presumptive presence of PRD according to the ESPD and such characteristics as age (χ² = 12.45, p = 0.004), social status (χ² = 9.67, p = 0.01), financial situation (χ² = 10.34, p = 0.008). Conclusion. In women, during the first year after childbirth, there is a high prevalence of symptoms presumably indicating PRD. With insufficient awareness of PPD, there is a high willingness to undergo screening for it.

In the first decade of the 20th century, the development of first Russian therapeutic elite has began. In addition to the recognized leaders (V. N. Sirotinin, V. P. Obraztsov, V. D. Shervinsky), this elite included a number of outstanding doctors of the “second echelon”. Leonid Efimovich Golubinin, a professor at Moscow University, should also be counted among them. This article provides corrected information on Golubinin's scientific biography, as well as analyzes the reasons that prevented him from taking a more significant place in the first therapeutic elite.

Minister of Health of the USSR G. A. Miterev in 1946 should have felt quite confident: for 7 years of work in a leading position
he had accumulated considerable experience as a health care organiser, the actions of the People's Commissariat of Health headed by
him during the Great Patriotic War were extremely successful, the post-war development of Soviet health care was going on confidently.
However, at the end of the year he was suddenly deprived of his post for attempted scientific cooperation with recent allies in the war —
the Americans: academician-secretary of the Academy of Medical Sciences of the USSR V. V. Parin during a business trip transferred to the
Soviet Union. During a business trip, Parin gave them samples of the anti-cancer drug ‘KR’ (krutsina) developed by N. G. Klyueva and
G. I. Roskin and the manuscript of a book on cancer biotherapy. The scientists were accused of anti-patriotic and anti-state actions, and
the minister was branded as an apolitical swindler. In June 1947, a trial of honour was held against N. G. Klyueva and G. I. Roskin, and in
August of the same year — against G. A. Miterev. All charges brought against them during these trials were dropped at a meeting of the
Presidium of the CPSU Central Committee in October 1959.

Medical and health tourism has developed significantly in recent years, driven by a variety of factors, including globalization, increased health awareness, and all kinds of innovations in medical technology and services. The article emphasizes that modern medical tourism includes not only receiving medical services, but also the opportunity to improve health in unique natural and cultural conditions. It is mentioned that the main factors contributing to this phenomenon include globalization, the development of technology, as well as the increasing awareness of the population about available treatments. The analysis of current trends in the field of medical
tourism, including outbound, inbound and domestic tourism, is presented. It also mentions a noticeable reduction in outbound medical tourism in Russia in 2023, caused by the geopolitical situation and changing preferences of citizens, which led to an increase in interest in domestic resorts and sanatoriums. The article summarizes that despite the existing challenges, Russia continues to develop its medical services, and the interest of foreign patients is growing, especially in areas such as ophthalmology, which opens up new horizons for medical tourism in the country.

The article identifies the key tasks of national healthcare at the present stage. The exceptional role of primary health care in maintaining the health of the nation has been revealed. The dependence of the guarantee of accessibility of primary health care on the level of provision of primary health care personnel is noted. The problem of shortage of qualified medical workers has been identified,
which results in a decrease in the quality of medical services provided. The study revealed a discrepancy between the labor intensity of medical workers and the amount of monetary remuneration they receive, which has a negative impact on motivation in terms of fulfilling professional duties. A study of the cost structure of primary care workers' working hours has shown that almost 50% of the time is spent filling out documentation, reducing work efficiency, staff interest and engagement. Given the high work intensity, responsibility for decisions made, as well as the different attitudes of employees towards their motivation, the following conclusion is drawn. When forming an incentive system, it is considered necessary to apply an integrated approach that includes both tangible and intangible incentive methods. This will ensure not only the maximum interest of primary care workers, but also increase the prestige of the profession, which, to some extent, will solve the problem of the shortage of qualified personnel.

Since 2018, Chapter 37 of Federal Law No. 323-FZ «On the Fundamentals of Citizens' Health Protection» and Article 40 of the Federal Law «On Compulsory Medical Insurance in the Russian Federation» have referred to clinical recommendations and the fact that medical care must be provided in accordance with clinical recommendations and taking into account the standards of medical care. At the same time, the deadline for medical organisations to switch to the provision of care based on clinical recommendations has been extended to 1 January 2025. At the moment there are no officially approved clinical recommendations for dentistry. Purpose: To study the opinion of dentists about the development and significance of clinical recommendations for dental care. Materials and methods of the study: qualitative survey of practicing doctors in different subjects of Russia. Results: Opinions of dentists about clinical recommendations differ depending on the level of knowledge, implementation and use. Conclusion: The development and implementation of modern clinical guidelines based on evidence-based best practice that practitioners will be able to refer to in simple and understandable cases is relevant in the Russian Federation.

Inpatient palliative care is primarily needed by adult patients over the age of 60 who have chronic diseases and a polymorbid background. Realizing the needs of patients and solving their urgent problems in inpatient settings is the main task of nurses. The study conducted in 2021—2022 confirmed the importance of the professional activities of nurses in solving problems and needs of palliative patients. The special conditions of professional activity for nurses are the severity of the patients' condition, since most often in their practice they encounter patients with various forms of cancer (85.0%, CI 81.4—88.6), severe irreversible consequences of cerebrovascular accidents (58.6%, CI 53.8—63.4), degenerative diseases of the nervous system in the late stages of the disease (40.2%, CI 35.4—45.0). Nurses in the professional field often face such groups of problems of palliative patients in inpatient settings, as pain syndrome (85.5%), manifestations of digestive disorders (60.3%), respiratory disorders (55.4%), slightly less — with mental and neurological (48.2%), as well as urological problems of patients (40.4%). The frequency of occurrence of problems and symptoms in palliative patients in the professional activities of nurses is presented. The leading problems in palliative patients requiring nursing care are constipation (86.5%), nausea and vomiting (80.0%), dry mouth (70.1%), shortness of breath (79.4%), urinary incontinence (75.9%), difficulty urinating (64.5%), insomnia (77.9%), manifestations of dementia (70.4%) and depression (61.6%).